ER Nurse Attitude - page 6

by Chlometov

8,692 Views | 70 Comments

A few weeks ago, my 89 year-old grandmother fell at her home, resulting in a bleeding gash in her arm (and later discovered, a broken hip). My mother took her to the emergency room. I wasn't there, so everything I write here is... Read More


  1. 1
    Quote from OnlybyHisgraceRN
    I know nurses are supposed to be full of customer service and compassion in all, but when we are busy running around with emergenices sometimes we may come off a little short.

    Tell your grandma not to take it personally. I wonder if people post about waitresses, police men, and teachers being rude. It seems as though nurses are suppose to be perfect.
    I can't speak for teachers but I used to waitress during my first stint at university and as I remember customers had all sorts of opinions and demands, not all of them reasonable. My previous career is 10+ years in law enforcement. My experience is that everyone and his brother had expert knowledge about the work I did, no matter what they actually did for a living. "You should have solved this without resorting to violence", "you should have used much more force", "why were you so rude or harsh","why didn't you position your people here or there" and so on and so forth ad nauseam.

    I think it's the nature of the beast. We have a job were we deal with people in volatile, stressful and emotionally demanding situations and we also have a position of power. We set the agenda. We decide when we see and treat the patients and how much time we devote to them. We provide the information.
    I'm not saying there is anything wrong with that, we have to triage and plan our work.

    I think that the combination of stress and a sense of lacking control is what makes most people "act out" against nurses and other health professionals. Well, some are just plain old rude but I think that they're a minority. The rest are just human with all that that entails
    Altra likes this.
  2. 0
    Quote from ktwlpn
    There really doesn't seem to be a middle ground between the two and in customer service oriented medicine the emphasis seems to be on the latter.Personally I would rather have a competent nurse or doctor then a touch feely one but the general public has no idea what we really do and they would not agree.I remember being called into the office for doing my nails at the nurse's station-I was actually reading tele strips.To add insult to injury the family member reported me because he wanted his grandmother's hair shampooed.It was after 2pm on a Sunday afternoon and his smelly bedridden grandmother was writhing in pain because he lived with her and had been stealing her morphine.He kept her bedbound so she couldn't see how much of the furniture and appliances he was selling.Her hair ended up being cut off of her head in one piece because it was so matted and she had pressure ulcers on every single boney prominence.She was a MESS.The office of aging got involved and she was in the hospital for a LONG TIME and the grandson was finally escorted off of the premises after he had disrupted the unit for several days. I never did get an apology from my nurse manager.
    First of all, I'm sorry that you were falsely accused when you were in fact busy doing your job. It always feels bad to have a finger pointed at you for something you did not do and then not receiving an apology.

    Your example is tragic, it sounds like that woman had been subjected to both neglect and abuse. However surely this grandson isn't represenative of the average relative who accompanies a family member to the emergency department? I'm not convinced that he can serve as proof that their isn't a middle ground between "matter of fact/curt" and "super sensitive touchy feely". I'd say that compassionate and informative is the middle ground and that it can be achieved in most (not all, but most. Sometimes it is truly chaotic and life-saving work takes precedence) encounters with patients or their friends and family.
  3. 1
    Quote from CountryMomma

    I hope that I can remain caring and connected to humankind, and my clients, as I begin my career, but more importantly, as I progress into it. I can't imagine why someone would continue to work in a place where all they do is cluck and roll their eyes at the very people they are supposed to be caring for.
    I think that you will do fine! You sound like your heart is in the right place and you have life experience. Of course with added experience of a particular profession comes an added understanding and the new insight might affect your current point of view. I'm convinced though that your basic personality traits remain the same and that you'll be able to use your own experience as the parent of a patient to treat your patients in a way that makes them feel seen, acknowledged and comforted.

    The best of luck to you in your future profession!
    NurseOnAMotorcycle likes this.
  4. 0
    Quote from That Guy
    Sorry I was rude. But the lac to her arm is at the bottom of my priority list as I am about to go do compressions/titrate pressors/assist with sterile procedures. Sorry I may have been a little rude to you but in times of distress, people remember things very differently and convey them to others as if the world was being destoryed around them while dear old grandma has a lac. While I try to make it in to every room in a timely fashion to assist in whatever injuries you/r family may have, please excuse my tardiness for attending other emergencies that required immeadiate attention first. As it was not an emergency, please kindly take your seat and wait your turn patiently. You would do the same at any other venue. My ER is no different.
    No one is questioning that at all TG. Just saying that people tend to get into certain modes of behaviors and responses, and they need to at least try to keep them in check. Esme said it best.


    And yes I do think there is a knowledge deficit with some folks, while with others, they missed the boat on empathy, and for some reason, it's all about them. Those people you could try to paint the picture for all day long, they aren't hearing/seeing it. So you keep it short and sweet and move on.

    Plus, certain people can escalate if you don't watch your approach and tone. Why make an already stressful situation worse? Being compassionate, professional, and doing the priorities can be done, but if for some reason, you miss the mark one day, strive to hit again the next day. I'm just saying, it's good to try and keep it in check. No one expects anyone to be perfect, Press Ganey or no Press Ganey.

    I get frustrated with people that can't see more than one side to something. It's becomes all about an "us versus them" mentality. Not really the mindset for professionals.
    Last edit by samadams8 on Jan 13, '13
  5. 2
    Quote from That Guy
    Sorry I was rude. But the lac to her arm is at the bottom of my priority list as I am about to go do compressions/titrate pressors/assist with sterile procedures. Sorry I may have been a little rude to you but in times of distress, people remember things very differently and convey them to others as if the world was being destroyed around them while dear old grandma has a lac. While I try to make it in to every room in a timely fashion to assist in whatever injuries you/r family may have, please excuse my tardiness for attending other emergencies that required immediate attention first. As it was not an emergency, please kindly take your seat and wait your turn patiently. You would do the same at any other venue. My ER is no different.
    But see...to them it's not. Their perception is not your perception...then to have their greatest fears confirmed by your response. That they aren't priority translate to...you aren't important. Accompany that with a short answer with attitude and rolled eyes....and you now have a war. Now neither side will hear the other. We are highly trained experts.....we should never assume that anyone knows how our specialized area functions in a matter of a few hours........ for it has taken us years to grasp and master the concept.

    I have said to the nurses in the ED I managed/directed that their jobs in the ED is to make the patients time with us as unmemorable as possible....ie: give them nothing to complaint about. I never expected to have raving review.....I was happy if I only got one letter per day of complaints. The ED is a high complaint area and the non medical CEO's or non clinical nurses with their PhD......have NO clue how they are run. They are like every other "civilian" out there in know what an ER does.

    Case in point. I once saw a very bright, experienced ED nurse get crucified by the administration when she failed to recognize the CNO (she was new and the CNO was....shall we say aloof and never seen by the staff) that was having chest pain/heart burn anterior localized no radiation (42y/o F, no history, no family history, ate spicy Indian for dinner) ambulatory to the ED tell the triage nurse her story as someone came running in shouting that they had someone in the car with bones coming out of their leg.

    Unbeknownst to the complaining CNO......Triage had an obvious radius/ulna....(it was by a ski slope) that was just arm boarded.....she watched the new to staff experienced nurse in triage run out calling for help assist and open tib/fib from the car onto a stretcher and into the ED.... when the triage nurse returned to triage the next "patient" was gone.

    She left without being seen only to call from the parking lot and raise a ruckus to have the nurse fired for not seeing her for chest pain. She then spent the next 3 days in ICU for her GB attack treating the staff like slaves.......that expert ER nurse was fired. (one of the reasons I left management is how non clinical upper management has become which I believe is ruining the beside, but that is another thread)

    The bottom line.......Perception is everything!~

    As humans we are flawed......and as ER nurses we will NEVER be able to please them all....but we should try. IN this case...... grandma not only had a lac she had a hip fracture. A quick drsg...so the family wouldn't have to look at the "bleeding...which we all KNOW won't cause anemia....a good assessment for a fall patient to be sure there was no underlying LOC....patient on coumadin....or hip fracture....caused by the fall to be sure there is a little delay in treatment as possible.

    SaoirseRN If people were literally dying, as others have said, sometimes it takes everyone available to manage the situation and there just isn't time. It would be nice to get grandma a gauze, but not if it means risking a life.
    I have been a nurse in an ED a LONG time and in some pretty harry situations....there is always SOMEONE.....who could provide simple assistance to patients. If not then the charge nurse needs to call the supervisor and get temp help to the ED by pulling an aid for a few.....I mean really not EVERY single staff member needs to be in the trauma room......I know there are incidences where you are rural and there is only one nurse ( I did that a few time agency...ED nurse ICU back up and house supervisor...the ED doc went home at night and the public rang a door bell to get in) but that is the exception to the rule.

    It is not the message but the delivery of that message that counts......I would always tell the staff..."A little compassion people, manners matter!!!!"
    Last edit by Esme12 on Jan 13, '13
    samadams8 and That Guy like this.
  6. 1
    My solution:

    Every single nurse and nursing student should have the opportunity to read survey comments as written by patients & families. Hospitals where I have worked transcribe them and distribute them to units, and I hope that that is done where you work, too. I really believe it's necessary to read these comments as they are written, word for word.

    To do so can be, initially, very upsetting. Use whatever coping mechanisms you need to work through this -- meditative thought, prayer, physical exercise, imbibing fine spirits, whatever ...

    THEN

    You can make the conscious choice to go on as a nurse, without the *ahem* cognitive dissonance that the OP is finding to be so distressing.
    Esme12 likes this.
  7. 4
    I was once aggressively confronted by a man wanting quicker care for his loved one. We were standing less than 6 feet from a full code in full view. I was trying to go for something now forgotten. When the man kept interrupting me and demanding more than we were able to give at the moment, I finally blurted out "what do you want us to do, stop CPR on that person to care for a non emergency?" Without hesitation he said loudly "YES!" My view of humanity changed after that. Forever after my answer was just a polite "we're doing the best we can."
    NurseOnAMotorcycle, OCNRN63, Esme12, and 1 other like this.
  8. 1
    Quote from Esme12
    But see...to them it's not. Their perception is not your perception...then to have their greatest fears confirmed by your response. That they aren't priority translate to...you aren't important. Accompany that with a short answer with attitude and rolled eyes....and you now have a war. Now neither side will hear the other. We are highly trained experts.....we should never assume that anyone knows how our specialized area functions in a matter of a few hours........ for it has taken us years to grasp and master the concept.

    I have said to the nurses in the ED I managed/directed that their jobs in the ED is to make the patients time with us as unmemorable as possible....ie: give them nothing to complaint about. I never expected to have raving review.....I was happy if I only got one letter per day of complaints. The ED is a high complaint area and the non medical CEO's or non clinical nurses with their PhD......have NO clue how they are run. They are like every other "civilian" out there in know what an ER does.

    Case in point. I once saw a very bright, experienced ED nurse get crucified by the administration when she failed to recognize the CNO (she was new and the CNO was....shall we say aloof and never seen by the staff) that was having chest pain/heart burn anterior localized no radiation (42y/o F, no history, no family history, ate spicy Indian for dinner) ambulatory to the ED tell the triage nurse her story as someone came running in shouting that they had someone in the car with bones coming out of their leg.

    Unbeknownst to the complaining CNO......Triage had an obvious radius/ulna....(it was by a ski slope) that was just arm boarded.....she watched the new to staff experienced nurse in triage run out calling for help assist and open tib/fib from the car onto a stretcher and into the ED.... when the triage nurse returned to triage the next "patient" was gone.

    She left without being seen only to call from the parking lot and raise a ruckus to have the nurse fired for not seeing her for chest pain. She then spent the next 3 days in ICU for her GB attack treating the staff like slaves.......that expert ER nurse was fired. (one of the reasons I left management is how non clinical upper management has become which I believe is ruining the beside, but that is another thread)

    The bottom line.......Perception is everything!~

    As humans we are flawed......and as ER nurses we will NEVER be able to please them all....but we should try. IN this case...... grandma not only had a lac she had a hip fracture. A quick drsg...so the family wouldn't have to look at the "bleeding...which we all KNOW won't cause anemia....a good assessment for a fall patient to be sure there was no underlying LOC....patient on coumadin....or hip fracture....caused by the fall to be sure there is a little delay in treatment as possible.

    I have been a nurse in an ED a LONG time and in some pretty harry situations....there is always SOMEONE.....who could provide simple assistance to patients. If not then the charge nurse needs to call the supervisor and get temp help to the ED by pulling an aid for a few.....I mean really not EVERY single staff member needs to be in the trauma room......I know there are incidences where you are rural and there is only one nurse ( I did that a few time agency...ED nurse ICU back up and house supervisor...the ED doc went home at night and the public rang a door bell to get in) but that is the exception to the rule.

    It is not the message but the delivery of that message that counts......I would always tell the staff..."A little compassion people, manners matter!!!!"
    Oh I agree, but that matter of fact is I am just one person and cant be in all 6 of my rooms at once and unfortunately that means that yes, some people are not important to me....at that specific time. I try my hardest to make everyone feel important and that they are worthy of my time, no matter how trivial and stupid their complaint can be. But you cant be everyone at once.

    That is also why I put in the part about peoples perception. We have people complain that they never saw a doctor their entire visit in the ED. When the doctor has been in 5-6 times and introduces themselves as the Doc/NP/PA EACH TIME. So maybe someone did put a dressing on and said something about the bleeding. We will never know. And the really sad part about the perception is that everyone perceives their specific problem as an emergency. Treat me now. I am more important than anyone here. No you arent. We even have a sign stating you will be seen BASED ON MEDICAL NECESSITY in triage.

    In the end what I would have done is called someone else who I knew wasnt drowning in patient load to help out, take a quick peak in and see what they could do. It is something I do all the time. Just quickly say "hey would you mind checking blank and blank, I havent had the chance to run in there yet". It is a simple solution to at least have someone make some contact. Like you said, there has to be at least one person.

    I agree with a lot of what you say. I think it is the ED newbie in me shining through a little.
    Esme12 likes this.
  9. 1
    Quote from dthfytr
    I was once aggressively confronted by a man wanting quicker care for his loved one. We were standing less than 6 feet from a full code in full view. I was trying to go for something now forgotten. When the man kept interrupting me and demanding more than we were able to give at the moment, I finally blurted out "what do you want us to do, stop CPR on that person to care for a non emergency?" Without hesitation he said loudly "YES!" My view of humanity changed after that. Forever after my answer was just a polite "we're doing the best we can."
    I like how you learned to handle it. I handle over-the-top families just like you. I come here to vent--or read about vents that give me the commisseration my psyche needs--but, as nurses, we can either escalate the situation with families or de-escalate it. I choose the latter--and then ***** about having to do that here!

    ETA: The most difficult family member I had in recent memory ******* about everything. EVERYTHING. That last interaction I had with her was about the food tray--after correcting a resident screw up in which they made the patient NPO for a procedure that wouldn't happen for three days!--and the daughter complained to me about no protein on the plate, which included an entree of lentil soup. I had to patiently point out to her that lentils have a lot of protein. She then went back and complained again about the NPO status, which I corrected after some investigation about when the procedure was supposed to happen. I said to her, "That's been corrected. I'm sorry about the mix-up." She retorted, "Yeah, thanks to me." And I just replied, "Yes. Thank you for pointing that out to me."

    Sometimes, ass-kissing is the only way to shut them the **** up.
    Last edit by dudette10 on Jan 13, '13
    anotherone likes this.
  10. 0
    We should, however be crystal clear in the fact that triage nurses need to know what is going on, what to do with the patient that is in front of them, and to advise patients that there will be a wait. ER techs should be tasked to take vitals, gauze on wounds, and to again say that there are critical emergencies that are in the ER, and that there will be a wait. This hopefully prevents the patient and/or family from then wandering about and interrupting a nurse in a critical situation when the nurse is immedietely needed elsewhere.


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